Abstract

Although screening for pre-cancerous cervical lesions and human papilloma virus (HPV) vaccination are accepted and effective means to prevent cervical cancer, women in Mali have limited access to these interventions. In addition, cervical cancer prevention by HPV vaccination has been controversial in some settings. To reduce cervical cancer prevalence and increase HPV vaccine uptake, it is important to understand the level of knowledge about cervical cancer screening and practices related to vaccination in at-risk populations. In this study, the level of knowledge about HPV and cervical cancer and attitudes towards vaccination were assessed among 301 participants (male and female, adults and adolescents) in a house-to-house survey in two urban neighborhoods in Bamako, Mali. The survey was combined with a brief educational session on HPV. Prior to the education session, overall knowledge of HPV infection and cervical cancer was very low: only 8% knew that HPV is a sexually transmitted infection (STI). Less than 20% of women had ever consulted a gynecologist and less than 3% had ever had cervical cancer screening. After hearing a description of HPV vaccine, more than 80% would accept HPV vaccination; fathers and husbands were identified as primary decisions makers and local clinics or the home as preferred sites for vaccination. This study provides information on STI knowledge and vaccine acceptance in Bamako, Mali in 2012, prior to the introduction of HPV vaccination.

Participants were asked about STIs (A), HPV (B) and cervical cancer (C) before and after a brief educational session. Percentages of participants able to answer the question are reported in the graphs for all participants (Total, N = 301), female (N = 148), male (N = 152) and adolescents (N = 146). * p<0.01 when compared to answers before the educational session (McNemar test). Women reported much more extensive knowledge of STIs than HPV, and while a brief educational session improved knowledge, more needs to be done.

Female participants (N = 149) were asked if they knew what CC screening was and about access to CC screening in Mali. Results are presented before and after the educational session for all female participants (Total, N = 149), female adults (Women, N = 75) and female adolescents (Girls, N = 74). * p<0.01 and ** p<0.05 when compare to answers before the educational session (McNemar test).

Willingness to be vaccinated against HPV and immunization preferences.

A. Willingness to participate in a vaccine trial and to get vaccinated was assessed before and after the educational session for all participants (Total, N = 301), female (N = 149), male (N = 152) and adolescents (N = 146). * p<0.01 and ** p<0.05 when compare to answers before the educational session (McNemar test). B, C: The preferred location to get the vaccine and the preferred method of contact for booster was assessed among participants who would choose to get vaccinated (Total, N = 253; Female, N = 113; Male, N = 140, Adolescents, N = 110). Interest in vaccination was high, two locations were preferred (local clinics (CsCOMS) and at home), and home visits rather than phone messages were preferred for reminders.

Participants were asked who would participate in the decision of vaccinate their children (adults, A) or themselves (adolescents, B). Results are shown as percentage of female ≥ 18 years (Women, N = 75), male ≥ 18 years (Men, N = 80), female <18 years (Girls, N = 74) and male <18 years (Boys, N = 72). * “Other” includes participants who did not answer the question. Women reported less autonomy regarding vaccine decision-making than men regarding vaccination for themselves and their children.

There are no patents, products in development or marketed products to declare. This study was supported in part by a research grant from the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp (MS&D). EpiVax, Inc. also provided funding in the form of salaries for author Anne S De Groot. This does not alter our adherence to PLOS ONE policies on sharing data and materials.